Although ICDDR,B has been involved in increasing the rates of contraceptive use for many years, we recognize that reproductive health encompasses a wide variety of issues that are important to families. High maternal mortality rates continue in Bangladesh and over 90% of deliveries take place at home without skilled attendance.
ICDDR,B scientists have contributed to the identification and documentation of the problems leading to high maternal mortality. Our projects have demonstrated how to improve basic obstetric facilities and to make them acceptable and effective at low cost. These include prenatal clinics, subcentres, safe delivery with trained midwives, and follow-up of women after delivery. The improvements prepare families for possible obstetric emergencies, including post-abortion complications.
ICDDR,B is conducting research to improve the way women are treated during pregnancy, during delivery, and following their delivery. We also need to learn how reproductive health services can best be delivered to people in rural and urban areas translating its model into a workable system for routine care of women.
Improving means to both prevent unwanted pregnancies and to address unsafe abortion remain important issues to address in Bangladesh. Complications from abortion are common and there is a need to improve management of post-abortion complications like infection, perforation and bleeding. Recent analyses of available data from ICDDR,B show that the total abortion rate is minimized by high quality family planning programmes. It also showed that unsafe abortion remains a leading cause of maternal mortality in Bangladesh.
Sexually transmitted infections (STIs) are common among commercial sex workers, they are also occurring in families not normally considered high risk. While more than one in three sex workers in one study tested positive for syphilis, about 4% of pregnant women attending a prenatal clinic in Dhaka were also infected. STI prevention will require behaviour change such as increased use of condoms, but effective treatment of current infections is required. Antenatal clinics will need to screen women for STIs in order to prevent complications, such as pelvic infections and transmission of infection to the newborn. Drug-resistant STIs are increasing rapidly and present a real danger.
HIV/AIDS is a major threat in Bangladesh because of the high-risk behaviour in many groups. Many individuals using non-sterile injecting equipment and purchasing sex commercially also have spouses, indicating a rapid spread from the high risk to the general population once an epidemic takes hold. These sexual networks have already led to the development of high rates of syphilis and hepatitis C, which is a likely indication for an explosive HIV epidemic in the near future.
A five-year collaborative effort under the Global Fund for AIDS, Tuberculosis and Malaria (GFATM) has found that adolescents have insufficient knowledge regarding reproductive health and practice risky sexual behaviours. Although youth in Bangladesh have awareness about HIV/AIDS they also have many misconceptions and very low risk perception, which may lead them to risky behaviour and a reduced sense of vulnerability. Information about HIV/AIDS is important but knowledge is not enough. Television is the preferred source of information however all forms of public media reach important segments of the general youth population.
Risky sexual behaviour is common among youth, and although condom availability is high, their use is unacceptably low due to the social norms and stigma associated with purchase. As a result, a significant number of youth are exposed to sexually transmitted infections, but diagnosis and care facilities are limited. Gatekeepers’ awareness about HIV/AIDS is high but knowledge on transmission and prevention is low. They are willing to act but few have taken any action, and know very little about existing prevention programmes in Bangladesh. General support for school-based HIV/AIDS education exists, however barriers regarding sex and condom education also exist.
The involvement of men is critical to the overall success of any reproductive health programme, and there is an urgent need to increase the scope of male involvement and identify ways to make it meaningful on a wide scale.